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Text File  |  2001-06-27  |  1.4 KB  |  46 lines
  1.  
  2. Battlejeep ordering form
  3. ------------------------
  4.  
  5. If you do not have access to the Internet, you can register via
  6. phone, fax or postal mail. Please print out the following form,
  7. and fax or mail it to:
  8.  
  9.  Register Now!
  10.  Dept# 2564-7
  11.  PO Box 1816
  12.  Issaquah, WA 98027
  13.  United States of America 
  14.  
  15.  Phone:
  16.       Toll Free: 877-353-7297
  17.       Regular:   425-392-2294
  18.  Fax:
  19.       Toll Free: 888-353-7276
  20.       Regular:   425-392-0223
  21.  
  22.  
  23. Personal Information
  24.   Program No.: 2564-7
  25.   First Name:      ___________________________________________
  26.   Last Name:       ___________________________________________
  27.   Company:         ___________________________________________
  28.   Street Address:  ___________________________________________
  29.   City:            ___________________________________________
  30.   State/Province:  ___________________________________________
  31.   Zip/Postal Code: ___________________________________________
  32.   Country:         ___________________________________________
  33.   Phone:           ___________________________________________
  34.   Email Address:   ___________________________________________
  35.  
  36. Order Information  
  37.   Quantity: ______
  38.   Price:  $15
  39.  
  40. Payment Information  
  41.   Name on Card: _____________________________
  42.   Type of Credit Card: ______________________
  43.   Card Number: ___________________
  44.   Expiration Date:  Month ________ Year(4 digits) _______
  45.  
  46.